Analysing Trump: Pitfalls and Professionalism

No political figure has ever mobilised, and frustrated, the mental health profession as much as President Trump.

Prior to Mr Trump’s inauguration, 3 professors of psychiatry called for a ‘neuropsychiatric evaluation’. Shortly after, with the first wave of chaos from executive orders and bizarre preoccupation with having won the majority vote, several social media comments started to trickle in, and continue to from several mental health clinicians, myself included. American psychiatrists are professionally barred from providing an arms-length diagnosis (known as the Goldwater rule, instituted by the American Psychiatric Association after Senator Goldwater was grilled in the media by psychiatrists speculating on his fitness for office), however several senior clinicians (such as John Gartner of John Hopkins University Medical School) have chosen to ignore it, citing their overriding civic duty.

The consensus diagnosis appears to be narcissistic personality disorder. The personality disorders refer to a group of conditions where people exhibit unusually exaggerated behaviours on a longstanding basis, often related to serious childhood disturbances. Things took an unusual turn recently when the principal author of the DSM criteria for the disorder, Professor Allen Frances, himself denied the diagnosis was appropriate. He cited that Trump does not exhibit distress secondary to his narcissistic behaviours, which he regards as an essential component of the syndrome. He opines instead that Mr Trump merely has an abhorrent personality, rather than an unwell one.

There are a number of problems. The first, and most obvious issue, is that none of the clinicians have actually formally interviewed Mr Trump. The second, subtler issue, is that most literature regarding personality disorders is prejudiced towards discussions of 20-40 year olds, which is when they tend to present most frequently for mental support. There is very little literature to advise an appropriate personality diagnostic approach for any 70 year old, let alone an arms-length assessment of the President of the United States.

History has had scant opportunities for mental health professionals to assess senior politicians. In 1939, the famous psychoanalyst Carl Jung had the singular opportunity to meet Hitler. Coolidge and Segal wrote, “Jung said Hitler never laughed, and it appeared as if Hitler was sulking and in a bad mood. Jung viewed him as sexless and inhuman, with a singleness of purpose: to establish the Third Reich, a mystical all-powerful German nation, which would overcome all of Hitler’s perceived threats and previous insults in Germany’s history.” At that time, despite Jung’s serious concerns and, unusual for him, outright fear, there was no framework in place to respond to the signals.

Mr Trump’s political opponents have unsurprisingly maintained this as an issue. Senator Al Franken has stated that “a few” Republican senators are concerned about the President’s mental health. Senator Sanders has called him a pathological liar, and not without clear reason. “When somebody goes before you and says that 3 to 5 million people voted illegally … nobody believes that. There is not a scintilla of evidence to believe that, what would you call that remark? It’s a lie. It’s a delusion.”

The obviousness of these observations is probably responsible for the worldwide outrage from the mental health fraternity, simultaneously muzzled by the ethical constraints of the profession. Perhaps Dr Greenhalgh of the British Medical Journal provides the most reasonable stance. As a general practitioner, she wrote, “When referring a patent to a hospital colleague, for example, I do not declare that patient X is suffering from disease Y; rather, I propose that the signs seem to point in that direction and that I would value an expert opinion and specialist diagnostic tests…I believe that there is no absolute bar to a doctor suggesting that in his or her clinical opinion, it would be in the public interest for a particular public figure to undergo “occupational health” checks to assess their fitness to hold a particular office.”

There is possibly much for the world, as well as for Mr Trump personally, should he ever undergo a psychiatric examination. History may see it as the single most beneficial act that mental health could have ever achieved.

Categories

Biological

Neuroimaging in Schizophrenia April 14, 2015
(The following includes content originally published in mindcafe)
The role of neuroimaging in schizophrenia detection and management is an exciting but problematic issue. On one hand is the promise of targeted ...

Flight of Ideas – Death of a Definition March 12, 2015
The term “flight of ideas” is commonly known, but do you know what it actually means? Or where it comes from? The disturbing answer to both of these questions explains ...

Glutamate and Dopamine – why it matters in Schizophrenia March 2, 2017
Published in MindCafe February 2017
Dopaminergic theories of schizophrenia predominate most psychopharmacological teaching regarding relevant receptor contributions to mental illness. We discuss dopamine-mediated flow through prefrontal and limbic regions, with a ...

The Carer Appraisal Scale – a new way to communicate. July 18, 2017
One of the commonest complaints of mental health services is a perceived failure of communication between caregivers and clinicians regarding those with mental health issues. With this in mind, a ...

Psychological

Psychotherapy at the APA April 14, 2015
(This article is a review of psychotherapy-related workshops and lectures at the American Psychiatric Association’s May 2014 conference. It involves content originally published at mindcafe)
The APA has a reputation for often being too biologically focused; however the psychotherapies were certainly ...

Euthanasia – the problem of capacity November 28, 2015
I once had a 70 year old patient with recurrent serious depressive episodes leading to suicide attempts. She was a “professional suicider”, in that she subscribed to an organisation that clandestinely posted out kits to help people kill themselves. I ...

The Role of the Father September 3, 2016
A famous study on parenting styles had two groups of psychiatrists being shown the same video clip. In the clip, a man is seen seated reading a newspaper, whilst his child is playing on the floor in front of him. ...

“Is it better to not exist?” May 12, 2016
A new update in the Journal of Applied Psychology provides a rebuttal against the soundness of a theory that supports abortion. In doing so, it provides an interesting framework as an argument against suicide.
Share this:EmailLinkedInFacebookGoogleRedditTwitter

Sociocultural

“Is it better to not exist?” May 12, 2016
A new update in the Journal of Applied Psychology provides a rebuttal against the soundness of a theory that supports abortion. In doing so, it provides an interesting framework as an argument against suicide.
Share this:EmailLinkedInFacebookGoogleRedditTwitter

Black Clouds After the Fires February 24, 2015
Post-Traumatic Stress Disorder following natural disasters – There has been a remarkable shift in how we respond to it, that has more than a little to do with common sense.
Black Clouds After the Fires
Share this:EmailLinkedInFacebookGoogleRedditTwitter

Videogames – friend or foe? January 12, 2016
Psychiatry has had an unusual relationship with videogames – and despite several hundred studies on the topic, it is still not clear how and to what extent they influence the mind. Do they encourage violence? And can they prevent dementia?
Share ...

Asylum seekers and mental health – a resolvable social problem April 14, 2015
It is difficult to maintain a consistent attitude, as a nation, to the issue of asylum-seekers. The extremes of “White Australia” are long gone since its final dissolution in 1973, however there is an ongoing fear regarding our vulnerability as ...

Why Doctors Commit Suicide March 28, 2015
This image – of an overwhelmed emergency physician dealing with the loss of a patient – went viral on the Internet. Trying to explain why leads to important considerations regarding how society behaves – and how doctors behave.
Share this:EmailLinkedInFacebookGoogleRedditTwitter

Recent Comments

Subscribe to Blog via Email

Enter your email address to subscribe to this blog and receive notifications of new posts by email.